Provider Demographics
NPI:1023203999
Name:THE CENTER FOR WOMEN'S HEALTH, PLLC
Entity Type:Organization
Organization Name:THE CENTER FOR WOMEN'S HEALTH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-534-0890
Mailing Address - Street 1:224 STARLYN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-2428
Mailing Address - Country:US
Mailing Address - Phone:662-534-0890
Mailing Address - Fax:662-534-6754
Practice Address - Street 1:224 STARLYN AVE
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-2428
Practice Address - Country:US
Practice Address - Phone:662-534-0890
Practice Address - Fax:662-534-6754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14886174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117218Medicaid
MS09015923Medicaid
MS09015923Medicaid